Tim O'Brien

November 21, 2021

3 min

We are living in a time when leadership is at a premium. This is especially true as we adapt to a “new normal” in our personal and professional lives. In the healthcare arena, the premium on leadership is multiplied by several factors.

  • We have a costly, opaque, anticompetitive, and inefficient system.
  • Health care represents 1 in every 5 dollars of Gross Domestic Product and continues to grow faster than any other consumer price index category.
  • Like food, housing, and a means to support oneself and one’s family, health is a deeply personal necessity. Illness, injury, and disease compromise our ability to meet life needs. A lack of access to health care or to affordable health care compounds the consequences of personal and family health challenges.

These factors should elevate the expectations of next generation leadership in the health sector and hold us to higher standards in our current efforts and especially in our capacity to influence change.

It is not my intent to define leadership here. This has been done many times in many places. However, I’d like to suggest that as executive leaders within a healthcare ecosystem that needs great improvements, we should hold ourselves to next generation aims and actions. Here are some tenets that might help to keep us pointed in the right direction.

Leading Healthcare with Integrity
1. Do no harm.*

Questionable practices across stakeholders in the U.S. healthcare, pharma, and insurance systems have shaken the foundation of trust. Many “solutions” created by the legacy industry and new entrants inherit the current system’s ethical challenges, such as egregious billing and shared savings, hidden fees, and unscrupulous contracts.

Many are smaller versions of the same problems. For example, direct contracting meant to address valueless provider networks is often based on the same model of discounts off price-blind billing.

As next generation leaders, we need to ask, and answer, hard questions. Are we creating and delivering integrity-based products and services? Are our decisions and actions improving affordability? Lowering barriers to access? Increasing transparency? Creating more competition? Eliminating conflicts of interest? Making things better for patients, care providers, and payers?

* Contrary to popular belief, “do no harm” isn’t actually a part of the Hippocratic Oath.

2. The majority is almost always wrong.

This is the reason ingenuity, innovation, and positive change can take hold in the first place. Consolidating entities in a compromised system, like the unchecked hospital, PBM, and insurance carrier acquisition activity over the past decades, worsens existing problems, monopolizes thinking, and homogenizes behavior. This creates a spiral of further system regression, making change much harder.

Next generation leadership asks “If we could start anew, what would we do?”

3. Incrementalism is a way to avoid real change.

Incrementalism is an attractive proxy for standing still. In our current healthcare system, staying the same means getting worse by default. We see this in the form of minor tweaks staged as major advances, such as ACOs and value-based care attempts to blunt out of control fee-for-service.

A variant of incrementalism involves offerings designed to “manage the racketeering.” Examples of this include industries that have cropped up attempting to optimize PBM contracts or engage in an auditing arms race with hospital revenue maximization specialists and systems.

Next generation health leaders are not afraid to create much needed separation from the mainstream with offerings that will seem audacious to the status quo.

4. Look out-of-field for solutions.

This is a hallmark of innovation and invention across all disciplines. What can we learn and adopt from operational efficiency in other industries? From healthier buyer-seller-customer arrangements in unrelated arenas? From financial transaction reinvention in other sectors? Or from businesses that take care of people in spaces outside of healthcare? Importantly, what can we learn from those at ground level every day in the current system?

5. Take risks.

Outside of medical research, the established system is averse to risk and change. This prohibits progress. It requires courage from leaders who will embrace the unknown to step away from the majority and make real change happen through better solutions. We need leaders who are not afraid to ask “What if…?”

v2.0 Healthcare Leadership

In our new normal, we are at a time and place that is ripe for next generation health leaders who have the morals and courage to lead with bigger, bolder steps. If not us, who? If not now, when?

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